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ideally selected to be greater than the magnitude of any increase in LOP normal-
ly expected during surgery due to changes caused by drugs used for anesthesia,
the patient's physiologic response to surgery and other variables.
Setting tourniquet pressure at a "standard" setting results in patients having too
high or too low tourniquet pressures, which can increase risk of injuries or bleed-
ing. Setting tourniquet pressure as a function of a patient's pre-op systolic blood
pressure is not best practice, as it does not take into account adjustments that
must be made due to differing cuff widths, differing degrees of match between
cuff shape and limb shape, differing degrees of snugness of cuff application to
the limb, and differences in the characteristics of the limb tissue beneath the
cuff. Setting tourniquet pressure as a function of LOP inherently takes into
account all of these variables.
Personalized tourniquet cuffs
Whether the patient is arthritic or athletic, bariatric or pediatric, always select a
personalized tourniquet cuff that matches the limb size and shape, tissue char-
acteristics and size of the patient. Also use personalized limb protection sleeves
that minimize soft tissue injuries underneath the cuff on the limb.
Personalized cuffs and sleeves designed to better match patient limb size and
shape provide more efficient application of cuff pressure to the limb, letting you
use lower and safer tourniquet pressures.
The traditional "straight" tourniquet cuffs are best suited to cylindrical
limb shapes. New types of cuffs are "variable contour cuffs" that let you
adapt the shape of the tourniquet cuff to any of a wide range of non-cylindri-
cal (tapered, for example) limb shapes. Cylindrical cuffs that are applied
onto a tapered limb result in poor fits, requiring the use of higher pressures
to occlude the limb.
OSM
Dr. McEwen (jamcewen1@gmail.com) invented the automatic tourniquet system for surgery. His
website, tourniquets.org, focuses on the safer and more effective use of tourniquet systems.
